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首页> 外文期刊>Psychosomatic Medicine: Journal of the American Psychosomatic Society >Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research.
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Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research.

机译：抑郁症和下丘脑-垂体-肾上腺激活：四十年研究的定量总结。

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OBJECTIVES: To summarize quantitatively the literature comparing hypothalamic-pituitary-adrenal (HPA) axis function between depressed and nondepressed individuals and to describe the important sources of variability in this literature. These sources include methodological differences between studies, as well as demographic or clinical differences between depressed samples. METHODS: The current study used meta-analytic techniques to compare 671 effect sizes (cortisol, adrenocorticotropic hormone, or corticotropin-releasing hormone) across 361 studies, including 18,454 individuals. RESULTS: Although depressed individuals tended to display increased cortisol (d = 0.60; 95% confidence interval [CI], 0.54-0.66) and adrenocorticotropic hormone levels (d = 0.28; 95% CI, 0.16-0.41), they did not display elevations in corticotropin-releasing hormone (d = 0.02; 95% CI, -0.47-0.51). The magnitude of the cortisol effect was reduced by almost half (d = 0.33; 95% CI, 0.21-0.45) when analyses were limited to studies that met minimal methodological standards. Gender did not significantly modify any HPA outcome. Studies that included older hospitalized individuals reported significantly greater cortisol differences between depressed and nondepressed groups compared with studies with younger outpatient samples. Important cortisol differences also emerged for atypical, endogenous, melancholic, and psychotic forms of depression. CONCLUSIONS: The current study suggests that the degree of HPA hyperactivity can vary considerably across patient groups. Results are consistent with HPA hyperactivity as a link between depression and increased risk for conditions, such as diabetes, dementia, coronary heart disease, and osteoporosis. Such a link is strongest among older inpatients who display melancholic or psychotic features of depression.
机译：目的：定量总结比较抑郁和非抑郁个体下丘脑-垂体-肾上腺（HPA）轴功能的文献，并描述该文献中变异的重要来源。这些来源包括研究之间的方法论差异，以及抑郁样本之间的人口统计学或临床差异。方法：本研究使用荟萃分析技术，对361项研究（包括18454名个体）中的671种效应大小（皮质醇，促肾上腺皮质激素或促肾上腺皮质激素释放激素）进行了比较。结果：尽管抑郁的个体倾向于表现出皮质醇升高（d = 0.60; 95％置信区间[CI]，0.54-0.66）和促肾上腺皮质激素水平（d = 0.28; 95％CI，0.16-0.41），但他们没有升高促肾上腺皮质激素释放激素（d = 0.02; 95％CI，-0.47-0.51）。当分析仅限于符合最低方法标准的研究时，皮质醇作用的幅度降低了近一半（d = 0.33; 95％CI，0.21-0.45）。性别并未显着改变任何HPA结果。包括老年住院患者在内的研究报告，与较年轻门诊样本相比，抑郁和非抑郁组之间的皮质醇差异明显更大。对于非典型，内源性，忧郁和精神病性抑郁症，还出现了重要的皮质醇差异。结论：目前的研究表明，不同患者组之间HPA多动的程度可能有很大差异。结果与HPA多动症相一致，HPA多动症是抑郁症与糖尿病，痴呆症，冠心病和骨质疏松症等疾病风险增加之间的联系。在患有忧郁症或精神病性抑郁症特征的老年住院患者中，这种联系最为明显。

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